Neurology Flashcards
1
Q
Peripheral vertigo will present with __________ nystagmus
A
Horizontal
2
Q
Sudden onset of tinnitus and hearing loss is usually associated with __________ vertigo as compared to central causes
A
Peripheral
3
Q
Management of nausea/vomiting
A
- Antihistamines first line - meclizine, cyclizine, dimenhydrinate, diphenhydramine
- Dopamine blockers - metoclopramide, promethazine
- Anticholinergics - scopolamine
- benzos
4
Q
S/E of scopolamine
A
Anticholinergic
Dry mouth, blurred vision, urinary retention, constipation
5
Q
Seizures not provoked by stimuli, occurs without clear cause
A
Epilepsy
6
Q
Generalized seizure which affects entire cortex. Muscle stiffness followed by muscle jerking. Will often have foaming of the mouth, tongue biting, and/or urination
A
Tonic Clonic Seizure
Grand-mal seizure
7
Q
Seizure that occurs in one part of the cortex with loss of consciousness
A
Complex partial seizure
8
Q
Seizure that occurs in one part of the cortex without loss of consciousness
A
Simple partial seizure
9
Q
Postictal symptoms
A
Confusion Amnesia Headache Nausea Difficulty speaking
10
Q
Paresis that occurs following a seizure that lasts for hours
A
Todd’s Paralysis
11
Q
Diagnosis for pt with first time seizures
A
CBC Electrolytes Glucose Calcium, magnesium Renal function, liver function Toxicology screen CT or MRI is also done to r/o masses
If all come back normal, this is termed epilepsy, and EEG is done
12
Q
Treatment for seizures
A
First time seizures usually do not require medication Reasons for therapy to be given: 1. Pt with status epilepticus 2. Prior brain insult 3. EEG with epileptiform abnormalities 4. Brain imaging abnormality 5. Nocturnal seizure
13
Q
Antiseizure medication with the most evidence for teratogenicity
A
Valproate
14
Q
Oral contraceptive efficacy may be _______ when started on an epileptic drug, therefore all women of childbearing age should be given _________
A
Reduced
Folic acid
15
Q
Treatment of choice for absence seizures
A
Ethosuximide
16
Q
Discontinuation of seizure medication can be attempted after:
A
2 year seizure free period
17
Q
Seizure that lasts longer than 5 minutes
A
Status epilepticus
18
Q
Treatment for status epilepticus
A
- Benzodiazepine (Midazolam used if no IV access)
- After benzo, give fosphenytoin
- If seizure persists but stable, phenobarbital
- If not stable, intubate and give propofol or midazolam
19
Q
Episode of neurological deficits caused by focal brain, spinal cord, or retinal ischemia without acute infarction
A
Transient Ischemic Attack
20
Q
Signs/Symptoms of stroke
A
Abrupt onset of neurological abnormalities
Facial paresis
Arm drift/weakness
Abnormal speech
21
Q
Signs/Symptoms of hemorrhagic stroke
A
Headache
LOC
N/V
22
Q
Diagnostic testing of stroke
A
- Non-contrast CT to r/o hemorrhage
- LP if negative but still suspicious
- MRI - localize extent of infarction (after 24 hours)
23
Q
Other tests for stroke to r/o other dz:
A
- Glucose - r/o hypoglycemia
- O2 sats
- EKG - r/o arrhythmia
- CBC
- Cardiac enzymes - r/o infarction
- PT/PTT
24
Q
All pts who present within _______ hours of ischemic stroke symptom onset should be offered TPA
A
4.5 hours
25
All patients who present after 4.5 hour window for ischemic stroke should be given:
Aspirin
26
Patients who have _______________ should not be given TPA
Rapidly improving stroke symptoms
27
In ischemic stroke, blood pressure should be lowered in the case of:
1. Malignant hypertension
2. Myocardial ischemia
3. BP > 185/110 and if TPA will be administered
28
Indications for mechanical thrombectomy in ischemic stroke
Occlusion of proximal anterior circulation
No hemorrhage present
Can be done w/n 6 hours
29
Treatment for hemorrhagic stroke
BP therapy - goal is 160/90
Labetalol and nicardipine are first line
If pt on anticoagulants, give reversal agent
Surgical removal or hemorrhage should be done if hemorrhage is > 3 cm in diameter or if patient is deteriorating
30
Ischemic stroke interventions:
1. ASA within 48 hours
2. Pneumatic compression stockings or heparin for VTE prophylaxis
3. Statin therapy
4. Smoking cessation
31
Long Term Antiplatelet Therapy after ischemic stroke
Aspirin, clopidogrel or aspirin-dipyridamole
| if pt was previously on aspirin - switch to clopidogrel or add dipyridamole
32
After stroke management (diagnostic modalities):
1. Echocardiogram - look for clot
2. EKG/Holter monitor - r/o AFib/arrhythmia
3. Carotid duplex US - r/o stenosis
4. Duplex US, CTA or MRA or head/neck arteries - look for clot
33
TIAs usually last < ________, but most resolve in ___________
24 hours
| 30-60 minutes
34
TIAs are most commonly due to:
Embolus
| or transient hypotension
35
_____% of patients with TIA will have a CVA within first 24-48 hours afterwards (especially if DM, HTN)
50%
36
Amaurosis Fugax
Monocular vision loss - temporary "lamp shade down on one eye"
Seen with internal carotid artery occlusion
37
Symptoms of TIA
```
Amaurosis Fugax
Contralateral hand weakness
Sudden HA
Speech changes
Confusion
```
38
Symptoms of TIA
```
Amaurosis Fugax
Contralateral hand weakness
Sudden HA
Speech changes
Confusion
Gait and proprioception difficulties
Dizziness, vertigo
```
39
Diagnosis of TIA
1. CT scan of head - r/o hemorrhage
2. Carotid doppler - carotid endarterectomy recommended if stenosis > 70%
3. CT angiography, MR angiography
4. BG to r/o hypoglycemia
5. Electrolytes
6. Coag studies
7. CBC
8. Echocardiogram
9. ECG - look for AFib
40
ABCD2 score
```
Assesses CVA risk
Age
Blood pressure
Clinical features
Duration of symptoms
Diabetes mellitus
```
41
Management of TIA
Aspirin +/- dipyridamole or clopidogrel
Avoid lowering blood pressure (unless > 220/120)
Reduce modifiable risk factors: 1. DM 2. HTN 3. AFib
42
Most common type of dementia
Alzheimer Disease
43
Loss of brain cells, amyloid deposition cells (senile plaques) in brain, neurofibrillary tangles (tau protein)
Alzheimer Disease
44
Diagnosis of alzheimer disease
CT Scan - cerebral cortex atrophy
45
Management of alzheimer disease
Ach-esterase inhibitors: Donepezil, Tacrine, Rivastigmine, Galantamine
Does not slow down disease progression
NMDA Antagonist: Memantine
46
Idiopathic dopamine depletion - failure to inhibit acetylcholine in the basal ganglia
Parkinson Disease
47
Cytoplasmic inclusions (Lewy bodies), loss of pigment cells seen in the substantia nigra
Parkinson Disease
48
Signs/Symptoms of parkinson disease
1. Tremor
2. Bradykinesia
3. Rigidity
4. Facial immobility (fixed facial expressions)
5. Instability (postural)
49
Parkinson disease tremor
Resting tremor most common (pill rolling)
Worse at rest and with emotional stress
Lessened with voluntary activity, intentional movement and sleep
Usually confined to one limb or one side before becoming generalized
50
Often the first symptom of Parkinson's Disease
Resting tremor
51
Slowness of voluntary movement and decreased automatic movements. Ex lack of swinging of the arms while walking and shuffling gait
Bradykinesia
| Parkinson Disease
52
Increased resistance to passive movement (cogwheel, flexed posture)
Rigidity
| Parkinson disease
53
Increasing speed while walking
Festination
| Parkinson disease
54
Tapping of the bridge of nose repetitively causes a sustained blink
Myerson's Sign
| Parkinson disease
55
Postural instability in Parkinson Disease
Pull test - stand behind patient and pull shoulders
| Patient falls or takes steps backwards
56
Dementia is seen in approximately ______% of parkinson disease
50%
57
Management of Parkinson Disease
1. Levodopa/Carbidopa (most effective)
2. Dopamine Agonists: Bromocriptine, Pramipexole, Ropinirole
3. Anticholinergics: Trihexyphenidyl, Benztropine
4. Amantadine
5. MAO-B Inhibitors: Selegiline, Rasagiline
6. COMT Inhibitors: Entacapone, Tolcapone
58
S/E of Levodopa/Carbidopa (Parkinson treatment)
N/V
Hypotension
Somnolence
Dyskinesia
59
S/E of Dopamine Agonists: Bromocriptine, Pramipexole, Ropinirole
(Parkinson treatment)
```
Orthostatic Hypotension
Nausea
HA
Dizziness
Sleep disturbances
Anorexia
```
60
S/E of anticholinergics
| Parkinson treatment
Constipation, dry mouth, blurred vision, tachycardia, urinary retention
61
S/E of COMT inhibitors: entacapone, tolcapone (Parkinson treatment)
GI sx
| Brown discoloration of urine
62
Postural, bilateral action tremor of the hands, forearms, head, neck or voice. Most common in the upper extremities and head
Essential tremor
63
Tremor increases with stress and intentional movement (finger to nose testing) - tremor increases as target is approached
Essential tremor
64
Essential tremor is usually shortly relieved with _______ ingestion
EtOH
65
Management of essential tremor
1. Treatment not usually needed
2. Propranolol may help if severe
3. Primidone if no relief with propranolol
4. Alprazolam third line
66
Bell Palsy has a strong association with:
Herpes Simplex Virus reactivation
67
Risk factors for Bell Palsy
1. DM
2. Pregnancy
3. Post URI
4. Dental nerve block
68
Sudden onset of ipsilateral hyperacusis (ear pain) for 24-48 hours - unilateral facial paralysis
Bell Palsy
69
Eye on affected side moves laterally and superiorly when eye closure is attempted
Bell phenomenon
70
Differential diagnosis: Bell Palsy vs Stroke
If patient is able to wrinkle both sides of forehead, it is NOT bell palsy
71
Management of Bell Palsy
No treatment is required - most cases resolve within 1 month
1. Prednisone
2. Artificial tears
72
Progressive, chronic intellectual deterioration of selective functions: memory loss and loss of impulse control, motor and cognitive functions. Includes language dysfunction, disorientation, inability to perform complex motor activities and inappropriate social interactions
Dementia
73
Risk Factors for dementia
Age > 60 y/o
| Vascular Disease
74
Signs/Symptoms of cluster headaches
1. Severe unilateral periorbital/temporal pain (sharp, lancinating)
2. Bouts lasting < 2 hours with spontaneous remission
3. Bouts occur several times a day over 6-8 weeks
75
Triggers for cluster headaches
Worse at night
EtOH
Stress
Ingestion of specific foods
76
Additional symptoms associated with cluster headaches
Ipsilateral Horner's syndrome (ptosis, miosis, anhidrosis), nasal congestion/rhinorrhea, conjunctivitis and lacrimation
77
Management of cluster headaches
1. 100% oxygen first line
| 2. Meds: sumatriptan or ergotamines
78
Prophylaxis of cluster headaches
Verapamil (first line)
| Ergotamines, valproic acid, lithium, cyproheptadine
79
Most common cause of morning headache
Migraines
80
Risk factors for migraines
Family history (80%)
81
Signs/Symptoms for migraines
Lateralized, pulsatile/throbbing headache
Associated with N/V
Photophobia/phonophobia
82
Triggers for migraines
```
Physical activity
Stress
Lack/excessive sleep
EtOH
Foods (red wine, chocolate)
OCPs
Menstruation
```
83
Auras
Seen with migraines (not commonly)
| Visual changes most common, aphasia, weakness, numbness
84
Management of migraines
1. Triptans or Ergotamines
2. Dopamine blockers: metoclopramide, promethazine, prochlorperazine
3. Mild: NSAIDs/acetaminophen first line
85
S/E of triptans or ergotamines
Chest tightness from constriction
N/V
Abdominal cramps
86
Prophylaxis of migraine
Anti-HTN meds: BB, CCBs, TCAs
| Anticonvulsants; valproate, topiramate, NSAIDs
87
Most common overall type of headache
Tension headaches
88
Bilateral, tight, band-like constant daily headache. Worsened with stress, fatigue, noise or glare (not worsened with activity like migraines). Usually not pulsatile
Tension headaches
89
Management of tension headaches
1. NSAIDs, aspirin, acetaminophen
2. Anti-migraine medications
3. TCAs in severe or recurrent cases
4. Can use beta blockers, psychotherapy
